Summer 2016: we offered a serial: ANRS-4D and the cheaters Summer 2017: we will debunk DOMONO:it starts here

This was originally published here, in French. We provide this translation for your convenience, practical aspects may differ where you live.

2017 Treatment hit parade

By Charles-Edouard!

Well ... My grandmother would have said "Cancer fore sure!". Well, we also have a new thing: Alzheimer ... My good old doctor, over-medication conscious, always said: "We would like to remove one of them, but which?"
My experience was taking this path ... Why say "alleviation is not for me"? We would like to say: quite the contrary!

My own Hit-Parade 2017

There are various rankings of meds (eg Morlat). One of the most relevant is the Spanish ranking.

Ours is not a recommendation, it is made exclusively from the perspective of refueled remission: the 1/7 (at least ...). These are, at most, considerations to have in mind when discussing with your doctor. Especially since the genotype (mandatory in France), may limit your options ... The ICCARRE exploration invalidates treatments based on IP or Isentress®, from 3/7. Obviously, there are ways simpler than others to reach the 1/7, and benefit from our predecessors, regardless of the medico-pharmaceutical propaganda.

Classics (see patents)
1 NNRTI	+ 2 NRTI	for 1/7, we may add, at 2/7	comments
Efavirenz	TDF + F-3TC	Abacavir (Ziagen®) or Videx®	This is Atripla®
	ABC + 3TC	TDF or TAF (Viread®) or Videx®
Nevirapine	TDF/F-3TC	Abacavir (Ziagen®) or Videx®	see bellow
	ABC + 3TC	TDF or TAF (Viread®) or Videx®
Modern ones  (usage for 1/7 is being explored)
1 INSTI/NNRTI	+ 2 NRTI	for 1/7, we may add, at 2/7	comments
Dolutegravir	TDF/F-3TC	nothing ?
	ABC + 3TC	nothing ?	This is Triumeq®
Rilpivirine	TDF + F-3TC	Abacavir (Ziagen®) or Videx®	This Eviplera®&/Complera ® see below
	ABC + 3TC	TDF ou TAF (Viread®) or Videx®

Know what to avoid

In the perspective that is ours, discuss with your doctor to avoid: PIs (Kaletra®, Prezista®, Reyataz®) and the 'older' INIs: Isentress®, Stribild® / Genvoya®)

Special case Nevirapine

The group of 'self-proclaimed experts' (we did not say independent experts ...) zapped NVP (document EACS). They also zapped their conflicts of interest declaration (Well ... While they are at it...)

NVP has limitations at initiation and gradually gets excluded from general recommendations. On the other hand, for maintenance, there are no such limitations. We have to make sure we do not have an allergic reaction, but, that's like everything else. This is Leibowitch's favorite molecule for his patent and the path to relative remission (1/7). You may want to switch to NVP using the NVP-switch-kit. As the path to 1/7, using RPV (or even DTG), is not chartered, yuo may want to return to ICCARRE orthodoxy. In switch mode, there are efw to none documented ontraindication. Once daily, it is generic. No medical congress in the West Indies ...

Special case Rilpivirine (Edurant® / Eviplera® : Complera®)

It's very much in vogue and has worked very well in 4/7 (ANRS-4D trial); it has not been explored further. To return to chartered routes, you may want to switch to NVP, using the NVP-Switch-kit or wait for a hypothetical trial in 3/7.

Special case Raltegravir (Isentress®) Elvitegravir (Stribild® / Genvoya®)

HAS has said and reiterated the low genetic barrier of Elvitegravir. In ICCARRE-1, Raltegravir 'trips' at 3/7. So, with that, if you think to go peacefully to 1/7, you have to explain! Moreover, the mere use of RAL or EVG creates an identified, known and published over-risk for DTG in reduced mode (Mono-DTG, or even, by extension, Bi-DTG and DTG / x in X / 7): this is the Achilles' Heel (Prof. Katlama). The bag is full and, for a 1/7 perspective, does not sound good! Their presence at the top of recommendations, not justiciable, open to abuse, speaks volumes. One may be able to correct for this, before considering 3/7, but may be not with Dolutegravir. It is still very limitating!

Special case of Protease Inhibitors (Kaletra®, Prezista®, Reyataz®)

In ICCARRE-1, PIs associated with 2 NRTI 'trips' at 3/7 ... So it's not ideal to move towards 1/7. No? If you can, you may want can go back to ICCARRE's orthodoxy by substituting an NNRTI, but then why did not we do it from the beginning? As an alternative (prospective), the combination of Tivicay ® (DTG) with Prezista ® or Reyataz ® is currently being explored in an x ​​/ 7 perspective (see here).

Special case Videx ®

Stock it! It is already no longer available in Switzerland ...

Counselors are not payers!

Beware of these so-called 'recommendations' issued by 'authorities' who are not and who are exempt from the ire of Justice and Democracy (Europe, unfortunately, has also become this too...). The recommendations of the EACS are irresponsible, in the sense that no one assumes the moral, sanitary or legal responsibility: it is to medicine what an advertising report is to journalism.

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Have a good Week, good fuck and do not abuse of meds/drugs

This was originally published here, in French. We provide this translation for your convenience, practical aspects may differ where you live.

Summer 2016: we offered a serial: ANRS-4D and the cheaters Summer 2017: we debunk DOMONO: it starts here

We Won!

By Charles-Edouard!

With 120 beats per minute120, the DUSTAN / REMES vs ACT-UP controversy resurfaces. About the death of DUSTAN, Wikipedia tells us:
Autopsy revealed: involuntary drug intoxication resulting in death. So stupid! By 2005, alleviation already exists... Unintentional drug poisoning causing death: see, this is why I am indebted to Leibowitch.

At first, it goes well, then the list goes on, the Rx holds on 2 pages. We add a little, to help a brains that escapes you. The great reaper lurks... The doctor, prescriber of death, will not be worried. Medico-pharmaceutical mob avoids accusation... But you, will you avoid drug poisonning?

Omerta: a reality

They screamed "Scandal!". Rightly so: re-read this post. The presentation by Leibowitch (4/7 and 1/7) was deplateformed, in last minute, without a word of excuse, by a committee co-piloted by ANRS (our good friends!). Once again we saw the power of the anti-ICCARRE clique: friendly and fraternal pressures, obfuscation, and even Stalinist retouching.

Obfuscation consists of mixing the nuggets and the scraps. For a blow snow job, trust C. Katlama! They mixed 4/7 among nonsense, so quickly forgotten.

Stalinist retouching, as we shall see later, consists in suppressing events afterwards. Thus the online video on youtube is amputated of Dr. Turkova's presentation. Well, yes ... They don't make our life easy.

The trick was to entrust the presentation to a pediatrician, without direct experience in 4/7, 3/7, 2/7, 1/7 (relative remission). A scientific congress, in Paris, has ignored the refueled remission, albeit fully demonstrated! And, of course, everyone congratulates microscopic advances... Donkeys scratch each other's backs ...

ICCARRE and the MORLAT recommendation, in front of the world

Download the slides by Dr. Turkova, the complete session here.

The Doctoressa, who, by her own admission was incompetent to speak of the 4/7, was therefore informed, in extremis, of key developments: ICCARRE and the MORLAT recommendation. It was necessary to urgently provide a translation of His Morlesque Holiness, which fortunately was already done. It costs me enough of my time so, when it is useful at the right time, I'm quite happy.

So ICCARRE was exposed to a world, amazed and enthusiastic! The recommendation of its use, MORLAT and ANRS (sic!), was revealed to a world, previously ignorant: Fiat lux! In the scorching torpor, our enemies allowed themselves to be overwhelmed.

The ICCARRE victory and unanimous ovation

The room is full! It's hot! Quickly, they open, not only one but, several adjoining rooms, with television broadcast (broadcast which will be truncated in the official release!). They are under shock! Ovation at the evocation of ICCARRE, general applause!!!

Let us not be mistaken, our victory is one of a battle in which the war is going on elsewhere ... We shall have to fight again in a guerrilla war maintained by those who fought against us, in the past, but it is only a question of time ... The final victory is assured, and quasi-remission for all is within reach.

As proof, the ignoble mob-in-white-coats tries to drown the ICCARRIAN universality in a so-called personalized medicine, on a case by case basis, which would be onerous for all. Certainly the Eclipse is variable, but since it lasts at least a week, for the super vast majority, please reserve 'personalized' medicine for some badly treated patients.

Leibowitch, a sought-after, revered, congratulated and even rewarded participant ... He will receive from the hands of Dr. Sidibé, Executive Director of UNAIDS, a magnificent badge. Here is our decorated Leibowitch, lacing up his ribbon beside his Legion of Honor.

Bareback also wins

Nearly one hundred presentations about PreP! The medico-pharmaceutical mob has not been idle! Jubilatory ejaculation for barebackers! Sure, Act-up does not find this funny... Their nostalgia ruins our lives!

So, explain us that this PreP attack is not a posthumous victory for barebackers...

Ah, I see ... You would like to know who is this doctor co-responsible for the death of DUSTAN ... Yes ... S/He is still active... We will discuss this one next time.



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Have a good Week, good fuck and do not abuse of meds/drugs

This was originally published here, in French. We provide this translation for your convenience, practical aspects may differ where you live.

Mono-DTG: all is fine

Summer 2016: we offered a serial: ANRS-4D and the cheaters Summer 2017: we will debunk DOMONO: - Dolutegravir and R263K - R263K: new scenario (DOMONO) - N155H: new scenario (DOMONO) - Nevirapine and Mono-DTG Switch: the Hunchback Trap - calculation error in the primary hypothesis - DOMONO and the benefit for the patients (not for BigPharma ...)

This was originally published here, in French. We provide this translation for your convenience, practical aspects may differ where you live.

Mono-DTG: a winner

By Charles Edouard!

In DOMONO, we will find the same failure rate as in BMM + P. Mono-DTG is of little interest to us. In a 1/7 perspective, based on Tivicay®, it can serve as a preamble to a remission strategy. Indeed, if one succeeds in Mono-DTG, one is perhaps in favorable conditions for the ICCARRE descent, either in Mono-DTG or in Bi (BiCycle strategy).

The DOMONO trial overrides proper selection and advice for better bioavailability!

Your Mono-DTG chances can be greatly increased with our Mono-DTG Practical Guide.

No harm to patients

As for the failures in Mono-IP (strategy to be avoided), a viral escape is clamped down by simple return to the initial triple therapy. Patients who fail will have, at the most, to go back, where they were already. And for those who succeed it is just so cool!

In all participants, ART was reinstated and CV was <50 within 12 weeks in all! (see here). The authors of DOMONO (results here), and BMM + P analyze that the attempt at Mono-DTG results in no loss of therapeutic option. And that's what counts!

HUGE benefit, except for ViiV Healthcare

We must admit that, for the time being, the idea of ​​a cyclical strategy (eg 4/7) does not make a good impression on people: they do not understand it, they are suspicious of it. The septists are septists to the marrow, to understand the Eclipse will be difficult for them. At the same time, the desire to take better care, with less, remains very strong: a bi or a Mono-DTG can be an intermediate solution.

The real prejudice is for those who do nothing, and stay in TRI ad vitam.

My readers testify: Mono-DTG is a real relief! I confirm!

A reader reminded me of the benefit when s/he went from Stribild® (4 molecules! And meal obligation) to Mono-DTG, so easy, so small to take, and, above all, so much better tolerated!

What to say to this 72-year-old patient, diagnosed late, with other health problems, CD4 = 1 (!), treatment naive , and that Dr. Lanzafame put under Mono-DTG, successfully? What to tell him? That he should have taken an infamous TRI, then wait a year before doing an ICCARRE descent (as if it were proposed to everyone!). Of course this patient is happy... Because seniors, under 5 ARV molecules, do exist!

Nevertheless, the patient has a choice! Just ban Mono-DTG because of a poorly run trial is ridiculous! Those who have been opposed a rebuke (read here) go elsewhere and they are right!

DOMONO is a useless trial, just good for the trash

It is a bad attempt, not just because I find the conclusion ridiculous and its interruption unjustified, but because it teaches us nothing ... Nothing at all ...

Where is the post-hoc analysis of the Achilles heel (yet incontestable, cf BMM + P)?
Where is the phenotypic (not genotypic) test for patient # 1, as promised in Oct. 2016?
Where is the critical analysis of mutations? And to forget that the R263K is beneficial ...

Ah ... We could identify the Hunchback trap... Well... We?... It's I ... Not the authors ...

Where is the benefit / risk analysis while the benefit is enormous? And the prejudice nul?...

Mono-DTG, it's still a so much better than MONO-IP! (strategy to be avoided, for that matter)

Practical Guide Mono-DTG

The Practical Guide (4/7) has moved the lines: it is copied here or there, and the Morlat recommendation boosted it well beyond my expectations

So I am writing a Practical Guide for Mono-DTG, confident that Morlesque oukase, will go, like DOMONO, to the trash.

Bicycle and MonoCycle Strategies

The Eclipse equation is valid in an efficient medication context, without imposing that it is a TRItherapy

The Eclipse exists whenever the treatment is effective. It does not prejudge "synergies" (there, one will have to explain me the whys and hows ...). The Eclipse results from a burial phenomenon (we'll get to this soon ...) that DTG promotes.

The Eclipse Equation, the deep burial of the proviral sequence, is been worked on, and we can begin to consider a long eclipse for all.

Today, there are enough individual testimonials of success under Bi or Mono-DTG cycles, to be interested in the issue. Especially since the Septists, anti-ICCARRE in their genes and interests, will soon jump on DTG + 3TC or DTG + RPV to lock their patients again in their everyday life straitjacket.

The temptation is too appealing in their camp: it is also in ours!

When you have an Eclipse (and who does not?), why not take advantage of it?

We evacuated DOMONO, that the Medico-Pharmaceutical Zealots will thrive on. Let's put this bad trial to the trash ... Too happy that we have learned some lessons, and better armed to resume our path to remission (refueled, of course...) by integrating this modern and relevant tool: DTG.

In the next few weeks, I will outline what a BiCycle Strategy would be (DTG / x in 4/7, 3/7, 2/7, 1/7 ...) or even MonoCycle (that then rejoins HypoDolu)

These many years to observe the inanity of ANRS convinced me that one does not enter the remission path by kowtowing rue de Tolbiac. Adios non-amigos!!!

We'll resume our normal schedule... Good Weekend, good fuck, not too many drugs, huh ...

DOMONO and the primary hypothesis

DOMONO and the primary hypothesis

Summer 2016: we offered a serial: ANRS-4D and the cheaters Summer 2017: we will debunk DOMONO: - Dolutegravir and R263K - R263K: new scenario (DOMONO) - N155H: new scenario (DOMONO) - Nevirapine and Mono-DTG Switch: the Hunchback Trap - calculation error in the primary hypothesis - DOMONO and the benefit for the patients (not for BigPharma ...)

This was originally published here, in French. We provide this translation for your convenience, practical aspects may differ where you live.
At first, we provide a Google translation, then we work on proper translation, which will come soon.

Patients lose confidence in medicine ...

Overmedication is on! Be confident... Inhibitors are not toxic, taking a treatment in advance is safe. Then comes the obligation to get tested, then that to get treatment. The same drama as with vaccines! And, it is much more profitable!

To make believe that it is necessary to treat at any level of CD4, one has adulterated a trial: START. By construction, it could produce no other result than the advantage to early treatment. The trick? Introduce a large group of pre-tuberculosis patients. If we exclude them, the result is reversed, as had been shown by years of British practice to initiate only below 350 ... CQD

S230R in DOMONO

The S230R mutation is associated with resistance only if it is associated with others. All of them do not necessarily confer resistance ... According to Stanford, here: S230R is a non-polymorphic mutation [...], which seems to have minimal effect, if any, on INSTI sensitivity.

It is not causal in the VL rebound, and, alone, does not confer resistance (cf: here). It has a NUL score for DTG, but not for RAL or EVG (see here). Achilles' heel? Go figure...

S230R can only be identified as RAM (mutation associated with resistance) only if it is not alone; But here it is alone! So, not a RAM. VL rebounds, it calls for action. Which? A resumption of TRItherapy (Eviplera®), as the authors did ? Or an addition of 3TC, as they recommend at the end of the trial? In the long run, ICCARRE still remains possible.

Here, it was not a RAM justifying a trial interruption...

More than 50% of failures are preventable

As with DOMONO, the BMM + P study excludes patients who had failed INI; BMM + P shows that more than 50% of failures are avoided by using the Achilles' Heel selector, which DOMONO does not. Unsurprisingly, we get as many failures as in BMM + P? Mostly avoidable failures!

The primary hypothesis is validated

Despite this, the non-inferiority hypothesis is validated! If the Morlat group is consistent, it could allow Mono-DTG in its next revision ;-)

Lorgeril explains, here, that we must define the primary hypothesis, in advance, and stick to it! And concludes: A trial stopped prematurely is worth no shit! Trash !

Fatal error: the undue safety interruption

The trial has been interrupted due to a safety trigger, on the pretext that the number of RAM exceeded the number of allowed RAMs, as per predefined safety conditions. Predefined conditions that we could not find anywhere... It comes out of nowhere: it is done with a wet finger.

This is quite debatable: indeed, the S230R, seen at S30, is not strictly speaking a RAM. But the two other resistances N155H and R263K are seen at S60 and S72, ie while the patients, technically, are no longer part of the study, which lasts for 48 weeks.

The error originates from that patients remain in the study beyond the time allowed, without releasing the bridle. This safety constraint is calculated from a permissible frequency, say 2 per year, that is multiple by time (1 year), which gives 2 ... But if the study lasts 2 years, then the trigger should be set at... 4.

Why are there S72 patients in a 48-week study??? They had difficulty recruiting: the recruitment was spread over approx. 1 year!!!

The main reason for stopping the trial was that there were too few participating centers, and that the investigators, who have defulted their expectations, had not reassessed the safety conditions to take into account the delay. Hopefully Hocqueloux, in MONCAY, who also has trouble recruiting, will be smarter!

All the statistical analyzes are based on the (doubtful) hypothesis that resistance is random, with randomness constant in time ... Therefore, advancing the date of initiation of treatment increases the time the patient is exposed to risk of resistance or suicidality. But, no one talks about it ... Of course...

The summer is coming to an end, our summer series will have one last episode, and then it's back to scholl, full lights on our victory, remissions, post-treatment controllers, bi-cycle short cycle (BiCycle Strategy), new results with Mono-DTG ... Oh, we'll have fun!

Hurry to the sea, the beach, sun and Love!

NVP, DTG: the Hunchback Trap

Summer 2016: we offered a serial: ANRS-4D and the cheaters Summer 2017: we will debunk DOMONO: - Dolutegravir and R263K - R263K: new scenario (DOMONO) - N155H: new scenario (DOMONO) - Nevirapine and Mono-DTG Switch: the Hunchback Trap - calculation error in the primary hypothesis - DOMONO and the benefit for the patients (not for BigPharma ...)

This was originally published here, in French. We provide this translation for your convenience, practical aspects may differ where you live.

NVP, DTG and the Hunchback Trap

By Charles Edouard!

An alarming testimony on drug availability, here

Plan ahead! We must plan ahead! Physician: Retirement or dispute, drugs: rupture or obsolescence; Insurance: loss or cancellation; treatments: escape or interactions, etc. It is the doctor who writes the prescription (and the patient who throws it in the trash)! In 2/7 one easily builds a comfortable stock (I have 5 years!), And then... DTG / 3TC is nice because it will be coformulated and widely distributed.
We're no longer alone, it's over! We have a community (see friends of ICCARRE), ICCARRE-friendly physicians, serious clinical trials and especially an ANRS recommendation (Morlat 2016). Even so, we must plan ahead!

For Switzerland: Dr. Jean-Philippe Chave, chemin Porchat 24, 1004 Lausanne, Switzerland (tel. +41 21 648 38 38) (limited Short Cycle experience)

NVP, DTG: the Hunchback Trap

We had seen (Dolutegravir, R263K and DOLUMONO) that R236K may appear or reappear with a drop in pharmacological pressure. It may 'be born' on this occasion; it can also be a vestige of the VL descent, and come back, on the occasion of an incident.

In the present case, for the R263K (a rather beneficial mutation) resurgence, replication would be necessary. However, this patient is supposedly undetectable ...

We have a replicative event, at S 60, certainly ... To be a vestige of the past, there should have been another replicative event! We do not see it ...

Well ... I was wondering about... You do not see it! This is a detective novel, the clue is somewhere.

Damn, but of course!!!

video Nostalgia

It is difficult to imagine how a patient, in continuous virological success, may have had a hidden replicative event ... And yet ... So in the middle of the night, it wakes me up (yes, yes...). Of course...

Come on...
Has the cat got your tongue? S/He originates from Nevirapine.

A new suspect... Already seen in: Dual therapy Guide: Coadministration of NVP / DTG lowers the concentration of DTG, the same magnitude as the bad absorption that happens at S60. Yes, but s/he did not take Nevirapine and Dolutegravir at the same time!

Let's have a look at Influence of nevirapine administration on the pharmacokinetics of dolutegravir..., by Eric Dailly, François Rafi (hi, hi, hi ...) et al.

It is explained that the coadministration reduces the concentration of DTG, at the same level as at S60. Certainly ... But there is no coadminstration ... So, you have to read carefully...

In stable patients under NVP + Kivexa, DTG is added for 5 days, followed by a noticeable decrease in DTG. NVP accelerates hepatic DTG metabolism. As expected.

What happens 15 days after stopping Nevirapine? The same effect is still clearly visible!

So you take your TRI-based Nevirapine, you switch to Dolutegravir in mono, and you have a window of at least 15 days where the concentration is greatly reduced: in a nutshell you can have the ideal conditions for the selection of the R263K, this fleeting resistance.

And the authors conclude: A small subset of individuals may require a doubling of dolutegravir with a twice daily dosing.

While we are at it, we look at our table and we see that 2 of the 8 failures occur with patients previously under NVP, whereas, typically, patients with NVP are rather few, and conversely, there are has no patient from an IP-based regiment (while typically representing 30-50% of patients)

And to conclude, wrongly maybe, that following a 1 NNRTI + 2 NRTI strategy (eg Atripla, Eviplera, etc.) with a MONO-DTG (or even a DTG) may present a risk.

This risk is neither confirmed nor quantified, however it is very easy to cover: just take 50 mg twice a day for a reasonable time, which is all the easier as this eventuality is written on the Tivicay® label.

It costs nothing, and can prove useful in increasing the success rate of Mono-DTG.

Why "Hunchback Trap" ?

It's simple: it's a trap from N. (NVP) to D. (DTG), a trap N.D. (Notre-Dame, Our Lady), a play of words that works only in French ...

Where you hoped for a double bevel, where one goes down while the other goes up, you can have a trap, during which the situation is not optimal.

Even if it is not true, it is well found!

Especially it is very easy to guard against it, so we will include it in the Practical Guide to Mono-DTG (under writing). Two precautions are better than one ...

Indeed, we want to put all the chances on our side, to be in the best conditions to address what really interests us: the short cycle in either Bi-Cycle (BiCycle) or Mono-DTG.

When we think that the secret desire of subsidized virology is to switch patients from NVP to Genvoya®, then going to 4/7 direct, it's chilling!

Our summer drama shows that Mono-DTG is more viable than DOMONO lets think!

Enough with brainstorming, let's go to the beach! Good weekend and good fuck!

https://charles-edouard-ma-liberte.blogspot.fr/p/essai-clinique-anrs-4d.html

N155H and DOMONO

Summer 2016: we offered a serial: ANRS-4D and the cheaters Summer 2017: we will debunk DOMONO: - Dolutegravir and R263K - R263K: new scenario (DOMONO) - N155H: new scenario (DOMONO) - Nevirapine and Mono-DTG Switch: the Hunchback Trap - calculation error in the primary hypothesis - DOMONO and the benefit for the patients (not for BigPharma ...)

This was originally published here, in French. We provide this translation for your convenience, practical aspects may differ where you live.

N155H in DOMONO

By Charles Edouard!

Testimony of by a sucker:

Genvoya® ... When patients discover that with Genvoya® they can not consider 4/7 nor the mono-DTG, they mare not too happy... What can I do? The error is in the choice of the virologist. In a predominantly feminized profession, we find that all Tempists are men (except for Breather where they are ... pediatricians ...). However, about 20-25% of the candidates to 4/7 (ANRS-4D and ICCARRE-2) are women. This sexual tropism of virologists deserves further study.

resistances shooting-gallery

In the ten green bottles, we had worked by elimination. There are several types of failure: random failures that reflect a random risk and predictable failures, therefore avoidable, which constitute a prognostic element in order to avoid the risk. This knowledge is obviously crucial for effective selection: it therefore does not contribute to rincrease isk but, on the contrary, reduces it.

When they launch DOMONO (DOLUMONO), they do not yet know the risk identified by Prof. Katlama: the Achilles' Heel. It is defined by the prior use of RAL or EVG. It is the prior use that constitutes the risk; A simple failure with RAL or EVG is not a satisfactory description of the Achilles' Heel. Of course, if one has failed with such an inhibitor, it is because one has used it ... Let's state it clearly: the Achilles' heel is the prior use and not the previous failure.

Unlike Barcelona Munich and Paris, those in Rotterdam absolutely did not understand the Achilles' Heel: they turn their backs to it, deny it, do not want to document it. Unlike the collaboration between BMM + P. The risk could not be known before it is identified ... By Oct. 2015 ... From then on, they had the opportunity to rework the files, document the Achilles' Heel and provide a constructive discussion . To this day, they have not done it!

N155H: What are you the name of?

One can only turn to BMM + P. There are 4 failures with emergence of N155H: B001, B004 (poor adherence and AH), B007 (AH), B008 (poor compliance). A selection algorithm that includes AH (Achilles Heel) and adherence reduces risk by 75%.

In the absence of information on a possible Achilles heel, one can only speculate. Therefor, why blame Mono-DTG?... It's a little too fast!

At no time do they question their selection criteria or improve the selection of patients. It is therefore a trial for nothing, not by the methodology but by the obstinacy of the investigators not to question their hypothesis. So much the worse for the patients, who will henceforth be rejected indiscriminately. Fortunately, we still have Hocqueloux, Lanzafame, Oldenbüttel, Blanco and Katlama.

Alternative scenario and choice of patients

One can make the Achilles' Heel and / or non-adherence an alternative scenario.

The failure is at week 72! It is a long way, however ... One can ask a few questions and recall that ICCARRE 4/7 is, de facto, a PreP: Mono-DTG, no ... The re-exposure to an already mutated virus is a possibility (Ah! The sexual promiscuity of Rotterdam!) to which Mono-DTG may not protect. Ah ... Bah ... Yes ... We have to dig a little ... And maybe put the risk of reinfection in a potential risk in Mono-DTG. Who knows...

Conversely, for the polysexual patient, DTG + 3TC or ICCARRE (4/7) are interesting alternatives.

Hopefully, Dr. Hocqueloux, in charge of the Moncay trial, will be better inspired.

In The News, Statins: The French Guidelines U-turn

Reminder: ANSM recommended statins, as prevention, so called primary. 6-7 million French were statinned (how many deaths?), Including 25,000 HIVers (albeit having already 3-4 molecules). The recommendation was voided by the Council of State (upon request by FORMINDEP) due to conflicts of interest of experts. The analysis of the studies, already old, and widely disputed, led the HAS to withdraw this deleterious recommendation. Le Figaro, a French paper in this article , clears, somewhat easily, its historical contribution to over-medication, to collective anti-cholesterol hysteria, by making false accusations to anti-statins. Yet what could they do but to bring to the public's attention the uselessness and dangerousness of statins, and the apparent bad faith of the industrialists? (So says Le Figaro)

Conflicts of interest? Bad faith of the industrialists? Toxicity concealed? Overmedication? Over-prescription? Misleading official recommendations? Turning into sneaky? Legal irresponsibility? Doesn't that remind you of anything?

Mutatis mutandis ... Ad nauseam

All this reveals the deception on a large scale, of which nothing (or almost nobody) has protected you. Are you taking statins? Go to an Independent and Caring Cardiologist!

Personal note: I started (100 mg DTG + 300 mg 3TC) in 1/7 (that's 1 Lamivudine less ...)

Go ... It's summer ... Enjoy the holidays, fuck, freemindedly!